Update: My New Nurse Practitioner Is Amazing!

2614Today I went to my first appointment with the nurse practitioner that my Certified Diabetes Educator (CDE) recommended to replace my old endocrinologist.  It was a little creepy at first, because her office is right across the hall from his office, and they have windows next to each door.  Literally like 5 feet away.  I tried to quickly scoot into the office before anyone across the hall saw me.  It was rather funny actually.  So I get inside, and wouldn’t ya know it, I remembered all kinds of crap to bring with me, except my insurance card!  I left my wallet at home!  I never do that???  *Gibbs slap*  Luckily, I’m such a geek, that I had the info stored in my address book on my phone. So no big deal.

Anyway, the first thing I liked about this office was there were health and exercise mags in the waiting room.  That’s a good sign.  The wait from my scheduled appointment time was about 45 minutes, but boy was it worth it.  Once I got to see her, I think we spent a full hour talking about my history, what I’m struggling with, baselines, prescriptions, attack plan, and so much more.  It was definitely a “discussion” and not her dictating, which is exactly what I hoped for if you read my last article.  I did not feel rushed like I always did with my last endo.  I’m really happy with her!

So here’s why I’m happy with her.  She did a FULL examination.  Not just a quick haphazard “lets pretend I’m listening to your lungs” kind of examination.  She checked my feet very closely since I told her about my beginnings of neuropathy.  She actually said I passed completely?!  She checked my infusion sites for scar tissue and infection.  We discussed my concern that the neuropathy could cause digestion and dizziness issues.  Answered my questions and set my mind at ease that she didn’t think it was affecting me that way.  She checked my ears and discovered I have wax packed on my eardrum which is probably what’s causing my dizziness.  Suggested seeing and ear nose and throat doctor.  She knows enough about nutrition to know that 125 carbs per meal is ridiculous (my last endo didn’t understand that), and she recommends a rather paleo style diet to her other patients.  She stays up to date on studies and research, and is active with the American Diabetes Association.  She’s willing to communicate with me via email.  No other doctor I’ve ever had have been either equipped, or willing, to do this.  They’re smart enough in her office to know how to access my pump readings and settings through the CareLink website at Medtronic, from their office, so they can go look at my settings and make a recommendation for changes via email.  OMG, HALLELUJAH!!!   A health care provider that understands technology!  They also are equipped to read my Dexcom and interpret it!  She does everything!  Oh, and when I told her I hated my Apidra and I wanted a script for Humalog again, she just gave me 2 bottles to take home with me.  Finally, since my A1C is still rather high at 8.4, she wants to tackle that right away and see me each week for the next 4 weeks.  Tweeking my pump settings, reviewing my exercise and meal notes, etc.

So now I want to reveal my nurse practitioners name, so that all my friends, family, and co-workers in the Quad Cities can know who she is, just in case you’d like a health care provider that’s amazing for your diabetes care.  Her name is Brenda Borkgren and she’s board certified in diabetes care.  Her specialties are listed as endocrinology, metabolism, and diabetes care.  For the time being, she’s accepting new patients.  She has offices in Bettendorf, Rock Island, and even Geneseo.  That picture at the top of the article is her profile picture.  If you have diabetes, and you’re fed up with your current diabetes care provider in the Quad Cities area, I recommend you make an appointment with her today.

[CLICK TO VIEW HER PROFILE]   http://www.unitypoint.org/clinics/provider.aspx?id=2614&clinicid=580&Brenda++Borkgren%2C+N.P.

Type 1 Diabetic: Insulin vs Glucagon

So I’ve been studying the role of glucagon in metabolism.  I wanted to know the difference between insulin vs glucagon.  I’ve never really known anything about glucagon, except that when I was a juvenile diabetic, I’d have seizures from low blood sugar, and when I saw my parents coming at me with that weird syringe, I knew it was glucagon.  They never understood that I was totally conscious during my seizures.  So anyway, I always thought glucagon was a form of ultra pure glucose or something, until I read Robb Wolf’s book “The Paleo Solution” back in March of this year.  He barely touched on glucagon, but did mention that it was a hormone, so I knew it wasn’t a form of sugar.

Well now I understand a great deal more about glucagon.  Been studying like a madman.  I understand that it’s insulin’s sister hormone, that they both come from Islets of Langerhans in the pancreas.  Glucagon comes from alpha cells, and insulin from beta cells.  That together, they are the core of metabolism.  A perfect feedback system that regulates energy in your body.  Glucagon is the yin, to insulin’s yang.  Glucagon releases fat to be burned, where insulin stores it for energy later.  Glucagon raises low blood sugar by signalling the liver to convert stored glycogen into glucose via glyconeogenesis.  When blood sugar rises to high, insulin is secreted to store that glucose as glycogen in muscle tissue, or as fat.  When there’s insulin, you can’t burn fat.  When there’s glycogen, you can’t store fat.  Insulin is secreted when you eat carbohydrates.  Glycogen is secreted when you eat protein.

Ok, so I have the basic understanding I think?  Now, as a T1D how does glucagon work inside me, since it doesn’t work at all inside me?  I can’t find these answers yet?  I’m dying to figure this out.  I know how insulin works in a T1D.  I just take it externally.  T1D’s don’t take glucagon externally except in emergencies though, to raise blood sugar quickly.  In a T1D, those Islets of Langerhans are broken, so neither insulin nor glucagon is secreted.  When a T1D’s blood sugar falls, glucagon doesn’t bring us back up like it does in a normal person.  Haven’t you ever seen a diabetic that’s hypoglycemic?  We don’t know our own name or where we are sometimes!  So if our bodies don’t secrete glucagon, how do we burn fat?  I know we as T1D’s need to take external glucose to raise blood sugar.  Does epinepherine work in a T1D for releasing fat to be burned?  If I understand epinepherine (it’s totally possible that I don’t understand anything about all this), it can function similarly to glucagon in the release of fat for energy.  I know that T1D’s can burn fat, because I’ve done it,  but how if glucagon doesn’t work?

If anyone reading this, can explain how a T1D burns fat for energy without a working glucagon system, I would be eternally grateful.  I know I’m trying to understand something  that’s probably a whole course of material, but I’d really like to understand this.  I’m such a health nerd.

Thanks for any help you can offer.

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